Last February the British royal house announced that monarch Charles III, 75, has cancer. Although no further data has been revealed about the type of tumor, it is known that the diagnosis occurred during an intervention to correct benign prostate hyperplasia, a very common medical problem among men over 50 years of age – although up to 8% of patients, may begin to show symptoms from the age of 30. Not in vain, it is estimated that one in two men over 50 years of age suffers from this disorder, a figure that reaches up to 90% between 70 and 80 years of age.
“It is very difficult to find a single man who does not have “complaints” about his prostate. In colloquial terms, this is what is called “prostatism”. Its symptoms are so common after a certain age that the strange thing is not having any of the symptoms it causes,” explains Dr. Nacho Díaz Lorenzo, vascular radiologist and interventionist at the La Princesa University Hospital in Madrid, to La Vanguardia.
Benign prostate hyperplasia, explains the spokesperson for the Spanish Society of Vascular and Interventional Radiology (SERVEI), can be considered a disease of old age, characterized by a growth of the prostate gland mediated by the effects of testosterone on the prostate tissue. (although there is no relationship between high blood testosterone levels and the development of symptomatic hyperplasia). “The prostate is located at the base of the bladder, in close relationship with the bladder sphincter, surrounding the urethra. As the gland grows, the urethra is compressed, making it difficult to empty the bladder, and this is where the symptoms associated with urinary retention typical of this condition appear,” says Díaz Lorenzo.
Among these symptoms are incontinence or urinary urgency, an increase in the frequency of going to the bathroom – which increases at night, with the consequent impact on the quality of sleep -, dribbling after urination or difficulty starting to urinate.
“It is an ailment that can greatly affect the quality of life of patients and sometimes, given the clinical characteristics it presents, it can make the patient feel embarrassed when asking for help,” emphasizes Díaz Lorenzo. The specialist highlights that early diagnosis and adequate treatment can slow down the appearance of symptoms, improve quality of life and, above all, avoid long-term permanent damage (which complicates the clinical picture) in the muscle that is responsible for contract the bladder due to the extra effort it has to make to overcome the obstacle posed by the prostate.
The treatment of benign prostatic hyperplasia largely depends on the severity of the symptoms. According to the expert, in patients with incipient symptoms or those with little impact on their lives, treatment can range from establishing changes in lifestyle (weight loss, limiting caffeine intake and fluid consumption per day). at night, improvement of the pelvic floor muscles with Kegel exercises, etc.) to the use of different families of drugs that seek to improve the degree of contraction of the bladder or reduce muscle tone at the level of the bladder neck to facilitate relaxation of the sphincter.
In the case of patients with more important symptoms (recurrent infections, bladder stones or who have already suffered an episode of urinary retention) and who do not respond to medical treatment, the usual practice until relatively recently has been surgery performed by urologists, usually through the urethra and using different techniques (laser, gas, vaporization, microwaves).
“Nowadays, the “pills or surgery” dichotomy has been broken. There are minimally invasive therapeutic alternatives with excellent results. This is where I believe there is a great lack of knowledge on the part of society,” says Nacho Díaz Lorenzo, who highlights in this sense the benefits of prostate embolization. It is a minimally invasive intervention carried out by vascular and interventional radiologists that consists of blocking the arteries that carry blood to the prostate to reduce its size and thus the symptoms. “It is a procedure that is performed through a puncture in one of the arteries in the groin. Through this puncture, a catheter is introduced through the artery until it reaches the prostate itself, where small particles are released that manage to “clog” those small arteries,” explains the SERVEI spokesperson.
This technique, which was initially used for the most fragile and older patients – those in whom surgery can pose a significant risk – is now also used for the treatment of younger patients, with symptoms and refractory to treatment with pills, due to the good results shown in the initial studies and their advantages over surgery.
“The only definitive treatment remains surgical intervention, but prostate embolization is a highly effective treatment that manages to improve symptoms and quality of life in nine out of ten patients treated with a minimally invasive, non-painful procedure, performed in a safe manner.” outpatient, that is, patients sleep at home and with low rates of adverse events, which means great comfort for the patient,” argues Díaz Lorenzo, who adds that from a technical point of view, embolization also has advantages over to traditional surgery, since it avoids classic surgical complications such as bleeding, urinary incontinence, retrograde ejaculation, erectile dysfunction and urethral stricture.
As experts point out, having benign prostatic hyperplasia is not a factor that increases the risk of developing prostate cancer, but it is advisable to rule out the latter, since the symptoms and signs of both ailments can be similar. In Spain, according to data from the report Cancer figures in Spain 2024, prepared by the Spanish Society of Medical Oncology, prostate cancer is the most common tumor in men. It is estimated that in 2024 diagnoses will exceed 30,300 new cases and its prevalence is notably high, with an estimate of 122,000 accumulated cases over 5 years in 2020.
“These figures place prostate cancer as an important public health problem,” says Dr. Rebeca Lozano Mejorada, scientific secretary of the SEOM and medical oncologist at the Salamanca University Care Complex, who highlights that early diagnosis is essential in the evolution of the disease. Currently, the expert adds, the vast majority of cases (80-85%) are detected in localized stages, where 5-year survival rates reach 98%. However, the prognosis is worse in those cases diagnosed in advanced stages, with lower 5-year survival rates (30-40%).
The main risk factor for prostate cancer is age and the majority of new cases are in elderly men, 90% of patients are over 65 years old and the average age of diagnosis is 75 years. Although there is a genetic risk component, only 10% of cases of this type of cancer have this hereditary factor, according to the Spanish Society of Medical Oncology.
“Although hyperplasia (growth or enlargement of the prostate) and prostate cancer can present with similar symptoms and signs, some specific symptoms such as hematuria (presence of blood in the urine), incontinence or urinary retention should be a reason for referral to a specialist to carry out a more exhaustive diagnosis,” recommends Lozano Mejorada.
Mejorada explains that patients who have suspected prostate cancer due to an elevated PSA with an abnormal digital rectal examination should be referred to a specialist in Urology, in order to perform a complete evaluation to determine if it is necessary to perform a prostate biopsy.
“It is essential that patients with suspected prostate cancer receive adequate evaluation and follow-up by a specialized medical team to ensure an accurate diagnosis and an appropriate treatment plan if the diagnosis is confirmed,” he concludes.
